31 January 2014

Reflections on the SUNRAY findings: Time for an African Nutrition Research Consortium?

This week saw the long anticipated publication in PLOS Medicine of "Developing a Sustainable Nutrition Research Agenda inSub-Saharan Africa—Findings from the SUNRAY Project" by Carl Lachat, Eunice Nago, Dominique Roberfroid, Michelle Holdsworth, Karlien Smit, Joyce Kinabo, Wim Pinxten, Annamarie Kruger and Patrick Kolsteren.

The 2 year project, funded by the EU, centres on discussions with 117 stakeholders from 40 African countries (by invitation only from the SUNRAY team, above) who shared their views (using participatory methods) on their priorities for nutrition research and actions to create an enabling environment for African research on African nutrition. 

What did they identify? The priority areas for nutrition research identified: "(i) community interventions to improve nutritional status, (ii) behavioural strategies to improve nutritional status, and (iii) food security interventions to improve nutrition."  

What is needed to support the African nutrition research? Priority actions identified for supporting African researchers to generate better evidence(and stimulate further demand from African policymakers) were: "(i) better governance of nutrition research, (ii) alignment of nutrition research funding with priorities identified within SSA, (iii) increased capacity development for nutrition research competencies, and (iv) enhanced information sharing and communication of nutrition research findings."

Some reflections:

  1. This is an important study. It is the first systematic listening exercise about what the African nutrition research community thinks.
  2. Many of the conclusions ring true to me—most of the research on African nutrition is defined outside the region. I don't think this is imperialism, just the lack of opportunity, support and resources to African researchers to publish, profile and share their work.
  3. I do think the governance of nutrition research is part of the problem and part of the solution—I agree with the governance recommendations made. The key is for real partnerships between the African researchers (who have more credibility and knowledge of the context) and western researchers (who have more resources and opportunities). The African Economic Research consortium (AERC) is an example of an African led model (focusing on economic growth) that is built on these partnerships, but with the agenda set by Africans. I would like to see something along these lines (an African Nutrition Research Consortium?) tried in nutrition. If nothing else it would help the nutrition community connect better to the economic policymakers in Africa who know the AERC model.
  4. I thought the problem statement could be defined more clearly. Is the problem mainly that research agendas set outside Africa for Africa tend to focus on the wrong things? Or is it that African policymakers will not listen to research from outside of Africa even if it relates to their country? Or is it just unjust and wrong to have non-Africans so influential in the nutrition policy agenda via research?  I would suspect it is all 3. For sustained national commitment we need policymakers demanding the right evidence and national researchers generating it AND researchers generating evidence that puts pressure on their policymakers. For this to happen the national systems need to thrive. National investment in research is key, but so too is external research support and too often donors are more influenced by their own nationals than by the nationals of the countries they want to support.
  5. While the SUNRAY project has done well in showing that there is an imbalance in terms of who is doing the research, I think the paper would have benefited from doing a better job of showing whether there is a mismatch between what research is needed according to the African research community and what the mainly non-African research community provides. I felt that the comparisons of the African priorities with the 2 papers cited in the paper were not really like for like. And the 3 priorities stated above do not seem (to me at least) terribly out of line with priorities set outside the region. 

But these are quibbles. So my warm congratulations to the SUNRAY team, and I would urge nutrition research investors--African and non African--to be responsive to these recommendations. Ultimately though this pressure has to come from African researchers--SUNRAY is a good start and the pressure must be maintained. 

30 January 2014

IDS Winter Graduation: Sometimes the struggle is the solution

Photo by Robin Coleman, IDS
Yesterday was Graduation Day at the University of Sussex and the IDS graduates were there to receive their degrees from the Chancellor, Sanjeev Bhaskar, a wonderful actor and writer.

Blackmail pictures of IDS students (and a few IDS staff) here.

The Chancellor, as usual, made some great jokes and told some great stories (he is a professional after all).

I love how he always tells the graduates about how, as an 18 year old, his application to the University of Sussex was rejected, and then he waited for all those people who made the decision to retire (or go mad) and then came back triumphantly as Chancellor (theme: don't let others define you -- and don't give up).

Also there was the story about the mouse in a bowl of milk who struggled so hard to get out it turned the milk into butter and so the mouse was able to walk out of the bowl (theme: sometimes the struggle is the solution).

Finally, there was this advice: when you boil vegetables, save the remaining water, freeze it and turn it into little cubes and use it as stock later on (theme: I have no idea!).

One of the parents I talked to afterwards was struck by the fact that the IDS students are the only ones who actually shake the hands of the Head of Department calling out their names (usually me) as they march onto the stage. I think it reflects the fact that IDS is a family and the students are every much a part of that.

So, my warmest congratulations to the 100 or so IDS students who graduated this year.

We know you will continue doing great things out there in the world, with the world, and for the world.

Just remember the mouse.

Ending Undernutrition: In Clear Sight?

How optimistic should we be about progress in global nutrition?  Global poverty rates have fallen dramatically over the past 20 years because of rapid economic growth in China, combined with its relatively low initial levels of inequality and its large population.   Will we see the same for global stunting rates because of progress in India?  Will India be the new China?

Well, the stunting declines (for under 2s) in the Indian state of Maharashtra between 2006 and 2012 have been dramatic--from about 39% to 23%-- a decline of 16 percentage points.  Maharashtra is a relatively well off state with a real commitment to stunting reduction so we might not see that level of reduction nationwide, but even if we saw a 10% decline across all of India that alone would reduce the worldwide number of children that are stunted from 165 million to 150 million.  The WHA targets for 2025 are a 40% decline in the number of stunted under 5 year olds, which is a target of 100 million.  So a decline of 10% in stunting rates in India by 2014 (and the NFHS4 national survey is reporting in the next year) will close 20% of this WHA gap in 15% of the time elapsed (2 out of 15 years)--so, well ahead of the global curve, even with only the India data.  Of course all-India might not show these declines in 2014 and other parts of the world might not either, but there is sufficient movement in commitment to be optimistic.

With that optimism in mind, and after asking politely why it took so long to follow up on the First International Conference on Nutrition (in 1992), here would be my introductory text (if asked) for the Second International Conference on Nutrition (ICN2, Rome, November 2014).

Ending Undernutrition: In Clear Sight 

For the first time in decades, the opportunity to end undernutrition is in clear sight.   The clarity is driven by a sense of being closer than ever and also by a much better grasp of what to do, why to do it and how to do it. Which elements are coming together to create this transformative opportunity, this perfect storm for undernutrition reduction?

First, we have the know-how.  We increasingly recognise that investments in nutrition pre and post conception are vital if we are to lock in a bright future for the next generation.  Increasingly we know what the most cost effective interventions are.  We recognise that multiple sectors have to work in harmony to achieve this step change in undernutrition reduction.  We realise that income growth is vital to support the funding of nutrition-related investments and that responsible and responsive governments are essential for the creation of an enabling environment where investments in nutrition are encouraged and, in turn, deliver improvements in nutrition outcomes. 

Second, the enabling environment is promising.  Climate change is an ever present uncertainty, but economic growth in the low and middle income countries is strong, generating increases in food security, improved water and sanitation provision, supporting empowerment for women and strengthening health systems.  This growth also generates tax revenues which can be invested in the social sector and to nutrition in particular.  Governance is also improving.  Government performance is increasingly recognised as critical for preventing the ravages of conflict; for making it easier for the private sector to do business and generate good jobs; and for allocating resources in an equitable way.  The commitment from development partners to nutrition has never been stronger, and is beginning to translate through into increased investments.   And if the High Level Panel’s report is indicative of a direction of travel, the post-2015 development goals will feature nutrition more strongly than the MDGs have. 

Third, we have examples which inspire us and which we can learn from.  There have been rapid declines in undernutrition rates in Bangladesh, Cambodia, Ghana, Peru, Vietnam and the Indian State of Maharashtra.  These places are achieving declines in line with the 2025 goals developed by the World Health Assembly through a combination of broad based economic growth, more responsive and responsible governance, and stronger, more strategic nutrition related investments.   They have a rationale for investing in nutrition and credible costed plans for doing so.  When these plans start delivering results they also generate widespread political support, helping to keep their governments in power and their citizens alive and thriving.  

Finally, many low and middle income countries are experiencing a once in a lifetime demographic transition.  For these countries the ratio of people of working age to those of nonworking age is going to peak in 2040.  If these new adults of 2040 can find decent work, this transition will represent a massive demographic dividend for their families and for their nations.  But this dividend will only be realised if the brains of those labour force entrants of 2040 were allowed to fully develop as infants 20-25 years earlier, allowing them to maximise learning in school and to raise their productivity in the labour force.  Flooding the labour force with young adults who have been undernourished as infants and are therefore less able to find gainful employment could well represent a demographic nightmare, one that is characterised by unemployment, unrest and violence. 

What needs to be done to deliver the demographic dividend and ward off the nightmare? 

First, we need to build up political commitment to reduce undernutrition.  We can’t wait for political will to materialise like manna from the skies, we need to build it from the ground up.  Undernutrition’s manifestations, budgets and accountabilties tend to be invisible.  How can we bring them into the light?  There are many ways of doing this: using new mobile technologies to monitor nutrition outcomes and programme coverage in real time; deploying new social accountability tools to empower citizens to tell us whether they are satisfied with the integrity and quality of efforts to reduce undernutrition, and taking advantage of rapidly expanding big databanks to monitor the commitment and actions of governments and others to reduce undernutrition.  Because reducing undernutrition requires many actors and many actions, it needs a relentless forward momentum of the kind that can only be powered by strong and enduring political commitment.

Second, we need to be more creative about mobilising resources for undernutrition reduction.  The additional funding needed to end undernutrition is not trivial, but it is also defendable.  For example, at best, nutrition investments comprise 4% of overseas development assistance ($5 billion out of $138 billion) despite undernutrition responsible for 45% of all mortality of children under 5.  This is the ODA situation, and it probably is reflected in domestic resource allocation.  Something is wrong with this picture.  Perhaps the mismatch occurs because while the benefits of undernutrition prevention are large – with benefit-cost ratios in the region of 20-30--the returns take a generation to materialise.  Current financial instruments cannot deal with such long lags—we need innovative new resource mobilisation models (development impact bonds for example) to help families and countries avoid an undernutrition trap. But this cannot be a public sector only responsibility.  We also need the private sector to join the fight, and bring in their own resources and know how, but on the terms of those who put public health ahead of private gain.  The private sector needs its consumer base to survive and thrive—for commercial as well as humanitarian reasons.

Third, these resources need to be invested in interventions and policies that have been shown to have an impact on nutrition.  The evidence base needs to be rigorous but diverse, a mix of demonstrable cause and effect and plausible pathways of impact. Nutrition specific interventions need to be scaled up. The arsenal of nutrition sensitive interventions needs to be expanded. The potency of the enabling environments created to stimulate undernutrition reduction need to match the more familiar ones created to stimulate general private sector investment. 

Finally, we need to build a new generation of nutrition leaders—from community health workers to prime ministers and presidents.  They need to be fearless boundary crossers, not easily captured by a sector. They should be idealistic pragmatists, not confined by ideology.   They must be alliance builders, as at ease with the political aspects of undernutrition as they are with the technical details.  These leaders are in demand but are in short supply.  Governments and development partners need to invest in the messy world of capacity development.  These leaders are the ones who build commitment and turn it into the actions that can end undernutrition.  

This is the world we are in.  We are in the midst of a perfect storm for nutrition.  Perfect because it has the power to sweep away all the old prejudices and misconceptions about nutrition.  Stormy because it has the power for transformative change, but also because it might blow itself out before it can do its good work.  Zero undernutrition is perhaps possible within the next 15 years or so, but it will require maximum effort from a wide ranging movement of people and ideas.  Make no mistake, we are members of a world citizenry that can actually make undernutrition invisible.  Not because it continues to do its silent but terrifyingly destructive work in the background, but because it will have become a thing of the past. 

24 January 2014

Sachs and Gates: optimists and idealists under fire

It is tough being an optimist these days.

First, I had a conversation with a journalist yesterday who was looking to write a story which challenged the claim by Bill Gates in his annual letter that "By 2035 there will be almost no poor countries in the world".

Mr. Gates is possibly correct if GDP per capita increases at about 3.5% for 20 years straight.  That will double GDP/capita by 2035 and so for countries that are at $500 per capita income they will get to the approximately $1000 threshold for what the World Bank classifies as "low income".

These are difficult and challenging targets but not ridiculous ones.  However, countries that are no longer classified as "low income" contain a lot of poor people (with India and the obvious case in point).

So even with increasing growth-poverty elasticities in Africa and better governance (and the majority of the countries Mr Gates is talking about are from this region), poverty will certainly not be abolished by 2035 although I believe it will be much much lower than it is now.

Second, Angus Deaton--one of my heroes--has, I think, been unfair on Jeff Sachs in his Lancet review of Nina Munk's book "The Idealist: Jeffrey Sachs and the Quest to End Poverty".

The basic critique of the Millennium Village Project initiative is: (a) it is an untested approach which is unlikely to work beyond the initial "sugar rush" of funds because it was conceived of outside of the contexts it is supposed to operate within, (b) the approach is not being properly evaluated --either for short term or long run effects and (c) it is the brainchild of Jeff Sachs who you either love or hate (neither for me).

But the review by Angus Deaton is too dismissive of the MVP idea in the absence of evidence (evidence we all believe should have been collected--see this letter from Bump, Clemens, Demombynes and me from the Lancet in 2012).

We should critique Jeff Sachs for not investing in evaluation (because perhaps he has such strong beliefs about the MVP--who know why?) but then you cannot dismiss the MVP idea in the absence of evidence simply because you also have strong beliefs on the other side.

Of course we need different blends of idealism, realism, optimism and pessimism for different challenges, contexts and times.  Balance is key and in the weak accountability world inhabited by international development that is perhaps the most difficult thing to be optimistic about.

22 January 2014

Nutrition Tweeters: More Needed

Blatant act of self-promotion 1:  here is the crowdsourced Guardian list of top tweeters on nutrition.   Some great ones in here, and a couple I did not know about, so thanks to the Guardian and congratulations to them (and GAIN) on the terrific new Hub.

Blatant act of self promotion 2:  two of the top 10 are the Convenors of the Transforming Nutrition Short Course at IDS, July 14-18 (Purnima Menon is the other convenor).

Tweets can be trivial but sometimes they can unblock thinking and unlock resources.  It depends how thoughtful they are and what they are linked to--content is still a vital part of a tweet.

Of course, the most important thing to blatantly promote is the need to scale up nutrition relevant actions and resources.  165 million stunted kids in 2014 is an outrage.

As the Guardian list shows we need more tweeters from the countries where the problem is the greatest (and great to see William Chilufya recognised), so if there is anything I can do to support you, please email me at l.haddad@ids.ac.uk and I will see what I can do.

20 January 2014

Transforming Nutrition Summer School, July 14-18 at IDS

Yes, it's back for a third year.

The Transforming Nutrition Summer School at IDS will take place this year from July 14-18 at IDS in sunny Brighton.

We ran this in 2012 and 2013 (picture above is from last year) and it has been a big success: lots of learning, insights and good fun.

We even got an unsolicited endorsement from a DFID colleague, Anne Philpott, who participated last year.

This year we will place emphasis on digesting the big events of 2013: the Nutrition 4 Growth pledges: what do they amount to? and the Lancet Series of 2013: what do they imply for action?

We will also explore the theme of 2014: what does accountability mean for nutrition and how we can all do this better?

The course is aimed at existing and potential nutrition champions and it is about how to best assess and use evidence to make the case for more and better nutrition-relevant actions.

This year the course will be led by me with my IFPRI and IDS hats on, Purnima Menon (IFPRI) and Nick Nisbett (IDS).

We will have special guest appearances by some of the big names in nutrition and we promise good weather (well, it has worked for the last two summers).

Details and online application are here.

For African participants coming from Africa we have 3 scholarships, with the brilliant support of Irish Aid, so please let us know if you are applying for those.

Please do not hesitate to email me with any questions. I am at L.haddad@ids.ac.uk (until April 26).  Thereafter L.haddad@cgiar.org

Apply soon--places go quickly!

14 January 2014

Undressing Patriarchy, Gender and Feminisms: 3 new publications

Amid the sense that some commentators have that the post 2015 debate is not addressing gender sufficiently deeply or widely, here are these three outputs that definitely help broaden thinking and make some interesting lateral connections.

First up a report called "Gender and Social Movements" by Jessica Horn, at BRIDGE, the specialist knowledge service bridging research, policy and practice on gender and development. The report notes that social movements--not always progressive--are vital drivers of change.  It also reflects on the challenges of getting women's rights and gender justice embedded within even seemingly progressive movements--the barriers that exist in wider society are often reflected in progressive movements. But when they can be successfully embedded the movements then become powerful drivers of change for women and for men. This is a really authoritative piece and highly recommended.

Second, is a new IDS Bulletin led by IDS Fellow Jerker Edstrom, called "Undressing Patriarchy: Men and Structural Violence". The central message of the Bulletin, about patriarchy, is not that men are in any way particularly evil, but rather that we are all involved in power structures which are gendered in different ways. Nor does the report fall into the temptation of trying to stereotype men – an unfortunate old trend in gender and development which it is strongly critical of. Rather than "down-streaming" masculinities to an issue for ‘poor men in crises of masculinity’ in the south it looks at it in the power structures of development itself -- turning the gaze back onto men and women like many of us who write about development. 

Finally, we have a new Zed book, "Feminisms, Empowerment and Development" by Andrea Cornwall (U. Sussex) and Jenny Edwards (IDS). The book explores what women are doing to change their own personal circumstances whilst providing an in-depth analysis of collective action and institutionalized mechanisms aimed at changing structural relations. 

08 January 2014

The public money available to manage the global environment: Are we using it wisely? Guest blog by Uma Lele

In response to Rob van den Berg's recent blog here is one by Uma Lele, independent scholar, former senior adviser at the World Bank and former IDS Board member.

"Rob Van den Berg, a longtime colleague has called a spade a spade in his blog on these pages. But not only is public money allocated to global environment small potatoes in relation to the resource mobilization potential or the need--it is spent far from optimally.

Most of the $10 billion of available public money is in the form of climate funds which have proliferated. In a paper I co-authored with Aaron Zazueta of Global Environmental Facility, and Benjamin Singer of the UN Forum for Forests we reported a total of 14 World Bank managed climate and carbon funds in 2010. Bilateral funds have also emerged reflecting further fragmentation of the aid architecture. Transaction costs to developing countries in accessing resources have increased without yielding significant benefits. Carbon prices in the EU market have dropped from around 9 Euros a ton in June 2012 to about 3 Euros in June 2013.

The learning curve on designing emission reduction projects is steep, measurement issues in assessing benefits abound and the benefits from this herculean effort are—so far--insignificant. Yet the growth of funds has spawned a consulting/NGO industry in advanced countries. Capacity in developing countries to address their multiple climate related challenges remains scant. The urgent need is to adapt to climate related disasters causing adverse impacts on millions of lives. Hence preparedness is of strategic importance, well demonstrated by the contrasting examples of the responses to hurricanes in October/November 2013 in Odisha, where a million people were moved, and in the Philippines, soon thereafter, where they could not be moved.

Among the mitigation efforts, REDD+ (reducing emissions from deforestation and forest degradation, forest conservation, the sustainable management of forests, and the enhancement of forest carbon stocks) gained momentum but now it too seems to be stalling. REDD+ deals with property rights, community participation, and benefit sharing—all are difficult to achieve in the short run. Carbon sequestration is measurable in principle, but it too is difficult to assess in practice.

Despite this, deforestation rates have slowed in Latin America (most notably in Brazil). Some middle income developing countries have added new forest cover to make up for the lost old growth forests. Tree cover outside forests has increased. This progress has occurred despite the absence of programs to independently verify and certify emissions reductions. It is explained by better law enforcement against illegal logging in Brazil, independent external verification of logging in Cameroon, greater vigilance by civil society organizations, and a growing desire on the part of the middle classes in developing countries to be environmentally responsive. The related carbon sequestration has cost as little as $2.50 per ton.

The current body of evidence supports three key propositions.

First, REDD+ needs to shift from a focus on forest carbon storage as a mitigation strategy to address other forest values, such as biodiversity, watershed protection, forest production, income generation, and social and cultural values of importance to stakeholders in developing countries. The current limited focus is neither sufficient nor sustainable without a land use, land use change, and forestry (LULUCF) approach as the Intergovernmental Panel on Climate Change (IPCC) has stressed. Attention to land change issues is critical, e.g., to agriculture and other uses, as well as to the many underlying issues related to REDD+ (e.g., international trade in commodities and private capital flows, technology transfers, and adaptation to climate change) involving diverse forest and agricultural lands and a large number of people dependent on natural resources.

Second, even with efforts on all these fronts, without mitigation in brown sectors (e.g., housing, transport, and energy) REDD+ is a fig leaf.

Third, stressing mitigation in developing countries alone diverts attention from need for mitigation in developed countries.

Part of making the case for more public money is to show that we can spend what is available in a wise manner. The evidence suggests these propositions will help us do this. "

06 January 2014

Is there enough public money to address climate change? Of course there is. Guest blog from Rob van den Berg at GEF

Here is a guest Blog by Rob D. van den Berg, Director, Independent Evaluation Office of the Global Environment Facility, a long time collaborator.

Climate Change negotiations keep promising huge amounts of money to support developing countries to solve their climate change related problems, and then falling far short of what is needed. The UNFCCC meeting in Warsaw in November again demonstrated this. The US climate change envoy, Todd Stern, told an audience at a Chatham House discussion in October that an increase in overall levels of public funding from developed countries is unlikely “to come anytime soon. The fiscal reality of the United States and other developed countries is not going to allow it.” He refers not only to the financial crisis but also to obligations to ageing populations, health care and other entitlements that are increasingly difficult to fund.

However, Todd Stern does not mention some other public policies that are actually contributing to climate change. In an evaluation for the Global Environment Facility we discovered that global public funding for climate change support to developing countries currently stands at about $10 billion annually. Assessments of the support needed consistently point to an amount that is at least ten times higher: $100 billion at the minimum. There is wide-spread agreement on these assessments and in the climate change negotiations the amount of $100 billion has been accepted as the goal to go for. However, governments from developed countries claim that they cannot raise this amount of money and that the private sector will need to contribute. They thus agree in principle with Stern’s argument that public money is simply not available in sufficient quantities.

They are wrong. Public money is more than sufficiently available. At least ten times more public money than needed can be redirected towards supporting developing countries on climate change. Authoritative research from the World Bank and IMF shows that more than $1,000 billion is going to subsidies that are contributing to climate change. Fossil fuels are subsidized throughout the world, thus increasing greenhouse gas emissions and making it more difficult for renewable energy technologies to take over markets. Not all of these funds are from developed countries, but the US fossil fuel subsidies alone amount to $24 billion annually, and redirecting it would provide a nice push in the direction of the $100 billion needed.

Climate change has been termed the biggest market failure ever, by another Stern: Nicholas, of the UK. He referred to the fact that market prices for energy cannot incorporate the costs associated with higher global temperatures, rising sea levels and other climate related changes which greenhouse gas emissions will lead to over several decades. Our climate is a global public good that needs public action to counteract the failing of the energy market. However, we see two kinds of public action at the moment: $10 billion annually for supporting developing countries in preventing climate change and at least $1,000 billion annually for promoting climate change through fossil fuel subsidies. Although almost all economists agree that fossil fuel subsidies should be stopped, they continue due to perceived political risks and economic lobbying. One argument has been debunked often and enough: that fossil fuel subsidies are needed for the poor. They in fact mostly benefit companies and the middle class. In fact the poor will be amongst the first to suffer from climate change.

The issue of inconsistent public action is one that plagues not only climate change, but also many other sustainable development issues. Take overfishing of the oceans. While there is general agreement that overfishing is now threatening the survival of many marine species, subsidies for fisheries far outspend public action to prevent overfishing. The challenge for public funding and public action is to not only take care of ageing populations and our health and education systems, but also to ensure that there is a sustainable future without poverty throughout the world. Our governments have more than enough public funds to tackle these issues. The goal of $100 billion annually for climate change support to developing countries can be realized from public funds without contributions from the private sector, just by redirecting money in public budgets. And substantial savings in public budgets can be achieved at the same time! It means we need to reinstate the “common good” in political discussions and break down the silos in which subsidies continue to undermine our future.


03 January 2014

The economic rationale for investing in stunting reduction: a useful graphic

Here is a rather groovy graphic (OK, it's groovy for an academic paper) summary of a paper I was involved in writing, which came out in Maternal and Child Nutrition last year.

Hoddinott, John, Harold Alderman, Jere R. Behrman, Lawrence Haddad, and Susan Horton. "The economic rationale for investing in stunting reduction."Maternal & child nutrition 9, no. S2 (2013): 69-82.

It might be useful in your advocacy efforts.